Dear Bethblomquist, I am sorry to hear about the skin issues you are experiencing. Unfortunately, for some people treatment with energy devices, such as lasers, can actually cause or worsen skin hyperpigmentation. You are doing the exact right thing by avoiding sun exposure and vigilantly applying sun protection. Make sure your sunblock contains either zinc oxide or titanium dioxide as these will provide you with the best protection. Please also know that heat itself can make your skin darken. In addition to sun protection/avoidance, I suggest you consider a prescription-strength lightening cream containing at least 4% hydroquinone or 15%-20% azelaic acid. You may also consider a series of superficial skin peels. If you decide to try a series of peels, make sure that you are also using a topical lightening cream at home in combination as directed by your physician. Gentle skin care and frequent moisturizing prevents irritation and inflammation, which can increase pigment formation. Lastly, it sounds like you may have an underlying condition called melasma. This is very common among women in their child-bearing years. Hormonal contraceptives can contribute. You may find it useful to familiarize yourself with this condition and to ask your doctor to explain it in more detail. Hope that helps! Brandon Kirsch, MD FAAD
Dear Loveandhappiness2018, Thank you for the question and what a lovely username. You have a beautiful smile and I can understand your frustration with the change since your treatment. Due to the large amounts and volume of Botox used to treat masseter hypertrophy, this is not uncommon. It will resolve! You will likely see gradual improvement over the next 2 months. While the atrophy of your masseter muscles will persist for some time (as intended), the effect of the Botox on the muscles responsible for your smile will wear off shortly. As you have suggested, treatment of your depressor anguli oris can improve drooping around the corners of the mouth and might be helpful. However, even experienced injectors may cause inadvertent treatment of depressor labii, causing lip asymmetry. My own advice would be to wait and see how things evolve over the next month or two. I hope that helps. Sincerely, Brandon Kirsch, MD FAAD
Dear Adali82, I can understand your worry and concern. It is often advised that patients avoid manipulation of areas treated with Botox for at least 4 hours post treatment. This is to prevent migration of the Botox to areas outside of the intended treatment sites. These recommendations are made out of an abundance of caution. After 24 hours of treatment with Botox the risk of physical manipulation of the skin or deeper tissues causing migration is virtually none. You received your deep tissue massage four days after Botox. Consequently, it would be extremely unlikely that you would have migration of the Botox from your massage. In addition, the distance of any migration would be only a few centimeters at most depending on the amount of Botox and dilution used. The unusual feelings you describe are probably related to the massage that you received itself. Please also be assured that Botox is temporary. Even in cases where an undesired change is noted, it will resolve with time. Usually in as few as 1-2 months but very rarely more than 4-6. I hope you find this information helpful. You may want to follow up with your injector if you have additional concerns. Sincerely, Brandon Kirsch, MD FAAD
